Problem-Solving Training: Effects on the Problem-Solving

Problem-Solving Training: Effects on the Problem-Solving

Eurasian Journal of Educational Research, Issue 64, 2016, 231-246
Problem-Solving Training: Effects on the Problem-Solving
Skills and Self-Efficacy of Nursing Students1
Gulsum Ancel*
Suggested Citation:
Ancel, G. (2016). Problem-Solving Training: Effects on the Problem-Solving Skills and
Self-Efficacy of Nursing Students. Eurasian Journal of Educational Research, 64,
231-246, http://dx.doi.org/10.14689/ejer.2016.64.13
Abstract
Problem Statement: Problem-Solving (PS) skills have been determined to be
an internationally useful strategy for better nursing. That is why PS skills
underlie all nursing practice, teamwork, and health care management, and
are a main topic in undergraduate nursing education. Thus, there is a need
to develop effective methods to teach problem-solving skills. The present
study, as a first study in Turkey, may provide valuable insight for nurse
academicians employed at üniversities.
Purpose of the Study: This study aims to determine the effect of problemsolving training, through a management course, on nursing students’
perceived problem-solving skills and self-efficacy beliefs.
Method: Study data, based on pretest–posttest application and a semiexperimental design, were collected using a socio-demographic data form,
Problem-Solving Inventory, and Self-Efficacy Scale. Data were analyzed
with the Statistical Package for Social Sciences (SPSS) version 15.0 using
definitive statistical analysis, the Wilcoxon test, and the Spearman
correlation test for inter-scale relations.
Findings: After training, the Problem-Solving Inventory (PSI) and SelfEfficacy Scale scores showed a significant difference (p<0.05). Regarding
PSI subdimensions, it was determined that students receiving training
perceived themselves as more competent in the Reflective Approach, the
Evaluative Quick Approach, and the Planned Approach (p<0.05), but
there was no difference in the Quick Approach, Abstention Approach,
And Self-Reliable Approach. A positive, medium-level but statistically
insignificant relation between perceived problem-solving and self-efficacy
has been found.1
This summary of the paper was presented at the 1st Eurasian Educational Research Congress
at İstanbul University in İstanbul, April 24–26, 2014.
1
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Gulsum Ancel
Conclusions and Recommendations: This study shows that training for
problem-solving through a structured management course improves
confidence in problem-solving skills and self-efficacy beliefs. In light of
this, nursing students should be trained in more creative ways than just
traditional methods, and PS strategies related to management should be
integrated into the nursing process. In this regard, academicians should be
aware of the importance of the teaching method used and the content of
the course. It is also considered that examining multidimensionally to
what extent the nursing process improves PS skills would be useful.
Further study is needed to clarify the relation between training programs
and perceived problem-solving in different samples.
Keywords: Nursing process, nursing, education, management course.
Introduction
Problem-solving (PS) skills have been used internationally as a strategy for better
nursing care (Hoyt, 2007). In order to give nurses a key role in the health care system
and activate them in developing, planning, and making policy in health care, the
Dreyfus Health Foundation (DHF) developed the “Problem Solving for Better Health
Nursing'' (PSBHN) program in 2002, focusing on nurses. DHF had pilot programs in
14 countries in 2005. The results of this programs show that the PS process has
increased the skill set and professional confidence of the nurses and strengthened
their leadership and also has improved the quality of services provided by nurses.
PS skills are the most important skills used in determining, practicing, and
evaluating nursing care for sick or healthy individuals (Wang, Lo, Chi-Hui, & Ya Lie,
2004; Lee & Brysiewicz, 2009). Institutions providing nursing education must raise
the PS skills of nurses in order to give qualified health systems the best chance to
solve the possible or actualized health problems of individual or groups. PS skills are
taught through the application of the “nursing process”education as scientific
problem-solving (Bayindir & Olgun, 2015; Burns, O'Donnell, & Artman, 2010).
The nursing process, which is called a PS process, is an organized, systematic
approach composed of collecting data, defining problems, determining interventions
toward patient care, intervening, and evaluating outcomes. It is possible to provide
effective, objective, and professional care by using the nursing process. Nurses have
to acquire PS skills in teamwork and health care management as well as in their role
of caregiving. That is why PS skill underlie all nursing practice and is one of the main
topics in undergraduate nursing education.
Nursing education includes a comprehensive PS education and PS skills can be
learned and improved through a nursing process education (Wang et al., 2004; Lee &
Brysiewicz, 2009). However, PS skills stand out as the least understood and least
studied topic, and studies show that PS skills of nursing students are insufficient,
*Corresponding Author: Prof. Dr., Ankara University, Faculty of Health,
[email protected].
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233
moderate, or of a low level. (Lee & Brysiewicz, 2009; Altun, 2003; Bayindir & Olgun,
2015). Studies assert that PS education has a significant effect on PS skills (Heppner &
Krauskopf 1987; Taylor, 2000). Yet some studies indicate that undergraduate nursing
education does not improve PS skills (Seyedfatemi, Moshir, Abadi, & Borimnejad,
2011; Altun, 2003; Kanbay, Aslan, Isik, & Kilic, 2013). According to Burns et al. (2010),
student acquisition of PS skills is impeded by many factors, such as the lack of
opportunities to practice PS skills and the challenges instructors face in teaching the
skills in realistic situations.
Studies concerning the relationship between undergraduate nursing education
and PS skills in Turkey show the gap between theory and practice: Nursing students
had difficulty in performing PS activities; they could not grasp PS procedures
adequately; and they were reluctant to utilize PS skills in clinical practice because
they found them difficult, time-consuming, and too theoretical (Olgun, Onturk,
Karabacak, Aslan, & Serbest, 2010). The study by Ulupinar (2007) proves that the
greater the exposure to PS training a four-year education, the greater the
improvement in PS skills; hence, PS education affects PS skills. Another study
monitors the change in PS skills among students receiving an integrated education
(Kelleci, Golbasi, Dogan, & Tugut, 2011). This study proves that PS skills improve
during the first three years, but that no improvement is made in the last year of
internship. Researchers of this study assert that the interruption in improvement may
be a result of problems concerning practice settings. Another study monitors the
change in first-year nursing students’ PS skills in a year, measuring them at the
beginning, middle, and end of the education term (Olgun et al., 2010). A significant
increase has been identified between the second and third measures during the
monitoring. This increase has been correlated with the initiation of PS education and
practice in the period following the second measurement. Contrary to these studies,
there are also studies which point out that there is no difference between classes
regarding PS skills and emphasizing that in most of these studies the students’ PS
levels are either low or medium (Ancel, Erkal-Ilhan, & Gencturk, 2015; Altun, 2003).
Interestingly, nursing students were not aware that they had received problemsolving training integrated into the nursing process (Ancel et al., 2015). Moreover, the
study by Bayindir and Olgun (2015), which is the only study conducted in Turkey,
examined the relationship between PS and the nursing process application skills of
nurses and found no correlation between them. However, the nursing process
education in Turkey based on PS skills starts from the second term of the four-year
undergraduate education and continues for 7 semesters. The students receive both a
theoretical and practical education on PS during each term for 8-16 hours per week.
It is interesting to find that the students’ PS skills stay at a low- to medium-level even
though they receive a lengthy period of education. Therefore, further studies should
be conducted to analyze factors concerning curriculums, students, educators, and
learning environments. All studies conducted in Turkey concerning PS skills and
nursing process have been descriptive; no experimental study has been found. The
studies carried out so far have determined the change in students’ level of PS skill,
but the correlation between this change and education has not been clearly proved.
Therefore this study, in a departure from previous studies, aims to analyze the effect
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of PS training on students' PS skills, as configured in the scope of a professional
management course in nursing. In addition, it is envisaged that good PS skills alone
are not adequate, that a belief in self-efficacy (SE) may also play a role in using PS
skills; to that end, the interaction between PS and SE belief was also examined. As
evidenced from a literature review, both PS and SE beliefs of nursing students have
been examined in various studies, but no study on their interrelation has been found
except the previously noted research by Ançel et al. (2015). This study seeks to
answer the following questions:



Does PS training affect the perceived PS skills of students?
Does PS training affect the SE beliefs of students?
Is there a correlation between SE beliefs and perceived PS skills?
The Concepts of Problem-Solving and Self-Efficacy
The concept of a problem is identified as the perceived gap between the existing
state and the desired state, in which an individual experiences mental confusion,
distress, or obstruction in reaching an objective. As for PS, it is a cognitive, emotional,
and behavioral process to cope with the obstructions, stress, and complications to be
solved (Heppner, 1978). PS is also used as a synonym of coping (Heppner, 1982). PS
is defined by Dewey as a way students reflect their lessons onto real life; reflective
thinking is acknowledged as an equivalent of the scientific method and has a
structure consisting of stages (Hermanowicz, 1961 cf. Dewey). Nowadays, the PS
process is accepted to consist of five stages: collecting data, analyzing the data,
determining alternative solutions, intervening, and evaluating.
PS is an important skill, necessary throughout a lifetime, present in all activities,
and requiring continuous improvement. After Dewey's discussion on PS in 1933 and
his view that education is life itself, PS skills became the main topic in education and
a field of study that many academicians concentrated on. According to Mayer (1998)
students should learn PS in a realistic setting, by practicing and knowing what to do
when. Mayer argues that an effective PS education is hierarchical and contains three
dimensions: a cognitive dimension that demonstrates learning ability (skill); a
metacognitive dimension that demonstrates gaining ability in a realistic setting
(metaskill); and a motivational dimension that demonstrates eagerness (will). This
conceptual model emphasizes the importance of motivation toward learning as well
as PS education in improving PS skills. In Mayer's model, the motivational
dimension is associated with three cognitive factors: interest, attribution, and SE.
According to Interest Theory, students will work harder and be more successful on
problems when they are interested. SE predicts that students work harder on a
learning task and understand the problem better when they have high SE. SE theory
also predicts that students who improve their SE will improve their success in
learning to solve problems. According to Attribution Theory, students’ PS behavior
depends on teachers’ reactions such as whether offering sympathy or pity to failure
or encouragement. Mayer’s model may prove a theoretical framework for the
relationship between SE belief and PS for educators when they teach. SE affects how
the student learns PS in an academic environment and a correlation is found between
academic success and SE belief (Gore, 2006; Zajacova, Lynch, & Espenshade, 2005;
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235
Zimmerman, 2000). Therefore, the effect of SE belief in improving students' PS skills
is essential.
SE, which has origins in Bandura’s Social Learning Theory, is the judgement of an
individual towards her/his capacity to successfully organize the activities in
achieving a task in certain conditions (Bandura, 1997). Bandura states that SE belief
arises from four information sources. These are listed as: mastery experiences, the
successful performance of an individual based on her/his own experiences; vicarious
experiences, which are indirect experiences, learning by observing others'
experiences; verbal persuasion, receiving positive feedback from other people
regarding her/his performance in carrying out the task; and, lastly, physiological or
emotional states, representing the individual's ability to regulate and explicate
her/his psychological and emotional arousal such as stress when faced with
problems.
A concept analysis of SE by Zulkosky (2009) explores the “feeling,” “thinking,”
and “behaving” dimensions of the cognitive model. In terms of “feeling,” a low sense
of SE is associated with stress, depression, anxiety, and helplessness. Hence, such
individuals fail to cope with potential dangers, become pessimistic about their
personal developments and accomplishments, and eventually lose their self-esteem.
In terms of “thinking,” it is suggested that a strong sense of SE facilitates cognitive
processes in a variety of settings such as decision making and academic achievement.
As for “behaving,” an individual’s level of SE is said to be directly influential on
his/her choice of activities.
SE is one of the main concepts in education, providing improvement in the
learning, succeeding, and motivation of the student. (van Dinther, Dochy, & Segers,
2011). SE belief shows that advanced students become more motivated in learning
activities, struggle and develop more effective strategies when faced with difficulties,
and give a higher performance (Bandura, 1997; Zimmerman, 2000; Eggen &Kauchak,
2013). According to Bandura (1997), SE belief affects people's decisions in
determining a goal, how much they will struggle to reach that goal, and how long
they will be able to face the difficulties they encounter or whether they will avoid
such difficulties. The concept of SE is also defined as the main concept of nursing
education (Robb, 2012). Robb's study shows that an increase in SE level resolves the
gap between theory and practice and makes it easier to gain clinical skills. Robb
(2012), in his paper reviewing publications between 1982 and 2010, affirms that
Bandura's definition of the cognitive dimension of SE belief and its four main sources
comply with nursing education. It is common to use these sources for enhancing SE
in nursing education. Correlated results indicate significant relationships between
SE belief and perceived PS skill for nurse and midwifery students (Ancel et al., 2015).
Beyond a doubt, aside from learning PS, students have to believe in themselves in
this respect. A cycle can be envisaged where students' strength of SE belief can help
them use PS skills effectively and, in turn, PS skills can increase SE belief.
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Method
Research Design
This study is pretest, posttest, and semi-experimental in design. A control group
could not be arranged because there was no second group. Measurements were
applied in the class, before and after training.
Research Sample
The participants were undergraduate, four-year nursing students from a
university, registered to a professional management course. Sample choosing was
not preferred and all 26 students willing to participate in the study were accepted.
Research Instrument and Procedure
The data were collected using a socio-demographic information form, the
Problem-Solving Inventory (PSI) developed by Heppner and Peterson (1982), its
validity and reliability tested by Taylan (1990), and a Self-Efficacy Scale (SES)
developed by Sherer and Madduks (1982) and adapted to Turkish by Gozum and
Aksayan (1999). The socio-demographic information form was used to identify
participants’ characteristics.
Problem-Solving Inventory: PSI is a 6-point, Likert-type scale with 35 items. It
reflects general perceived PS skills, and the scoring limits are between 32 and 192; the
average score is 80. Low scores (under 80) show high confidence in PS (Table 1). The
scale has 6 subdimensions, namely, Reflective Approach, Evaluative Approach, SelfReliable Approach, Planned Approach, Quick Approach, and Abstention (Skeptical)
Approach.
Table 1.
Interpretation of the Scores of the Problem-Solving Inventory
Subscales
Increase in
Decrease in
Scale Scoring
Scale Scoring
Subdimensions measuring
the
type
of
positive-desired
approaches (Reflective, Self-Reliable,
Evaluative, Planned)
Individual uses the
positive approaches
less
Individual uses the
positive approaches
more
Subdimensions measuring the type
of negative-ineffective approaches
(Quick, Abstention)
Individual uses the
negative approaches
more
Individual uses the
negative approaches
less
Problem-Solving Inventory
Perceived PS skills
is negative
Perceived PS skills is
positive
Eurasian Journal of Educational Research
237
Self-Efficacy Scale: SES is a 5-level, Likert-type scale with 23 questions and
measures general SE belief. The scores of the scale are between 23 and 115. The high
scores indicate higher SE belief. Although the scale has 4 subdimensions, total
scoring instead of the use of subdimensions was recommended, because the Turkish
version of the scale differs from the original one. Therefore, the results of this study
were evaluated according to the total scores.
Before starting, the necessary institutional permissions and informed consent
from participants were taken. The students were given 7-week training composed of
8 hours theory and 56 hours practice as a part of the professional management
course. Theoretical contents of the training include the following issues:
Conceptualizing and defining a problem, specifying alternative solutions, deciding
on a suitable solution by comparing the advantages and disadvantages of the
options, organizing the practical steps for carrying out the solution, and determining
the conclusive outcomes for evaluation. As part of the theoretical education,
techniques such as the Pareto Analysis to determine the priority of problem, “CauseEffect Diagraming” to analyze the problem, and “SWOT Analysis” to evaluate the
strengths (S), weaknesses (W), threats (T) and opportunities (O) in PS are taught. The
theoretical education is supported with in-classroom practices, individual or group
practices, homework, and, lastly, clinical practices. The students are first encouraged
to use exercises learned in the classroom for their own lives, and secondly to practice
them in university hospital clinics.
Validity and Reliability
In terms of the reliability of the scales, a test of Coefficient Alpha (Cronbach’s
alpha) was conducted. The scale's Cronbach alpha coefficient of PSI in Taylan's study
(1990) was found to be 0.88 while in our study it was 0.87. The Cronbach’s alpha
coefficient of SES was 0.81, while in this study it was estimated at 0.85. Completing
the questionnaire and scales took approximately 20 minutes.
Data Analysis
The data was evaluated with the Statistical Package for Social Sciences (SPSS)
version 15.0, and the Wilcoxon test was used to determine the difference in students'
PSI and SES scores pre- and posttests; the Spearman correlation test was applied
concerning the relation between scales. The significance level was accepted as 0.05.
Findings
Students’ age mean was 21.9 ± 1.38, 92.3% of were girls, and all were single; mean
academic success was 2.6 ± .31. About 4. 65% of the students stated they had lived in
cities before university and during education, and 61.5% were living with their
families while 38.5% were living with friends. The mothers of 15.4% of the students
were illiterate; most (73.1%) had only primary school education and were
housewives (96.2%). The fathers of 3.8% of the students were illiterate, 76.9% of them
had primary and secondary education, and 19.2% of them attended university; 88.4%
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of them were employed as civil servants or workers. Students stating that they had
not received PS training during their undergraduate education accounted for 80.7%
(Table 2).
Table 2.
Socio-Demographic Characteristics of Students
Characteristics
With whom they live
Family
Friend
Alone
Place of living before university
Village-town
City
Educational level of mothers
Illiterate
Primary school
Secondary school
University
Educational level of fathers
Illiterate
Primary school
Secondary school
University
Living place of family
Village-town
City
Received PS training before
Received
Not received
n
%
16
10
0
61.5
38.5
0
9
17
34.6
65.4
4
19
2
1
15.4
73.1
7.7
3.8
1
13
7
5
3.8
50.0
26.9
19.3
82
161
33.9
66.1
5
21
19.3
80.7
The students' PSI total scores were determined as 87.0 ± 16.7 before training (low
between 81 and 192) and 82 ± 12.9 after training (the level of satisfaction increases as
the scores decrease). After training the students' perceived PS skills improved and
reached medium-level. As a result of the training, it was found that the
subdimension scores of the PSI's Reflective Approach, Evaluative Approach, and
Planned Approach changed significantly and the students perceived themselves
more competent in these subdimensions (P<0.05). On the other hand, the
subdimension of the Self-Reliable Approach, although being statistically
insignificant, maintained a positive difference. However, the PSI's Quick Approach
and Abstention Approach that are mentioned as negative dimensions did not have a
significant difference (p>0.05).
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239
The students' SES scores were identified as 85.23 ± 11.8 before training and 94.35
± 9.3 after training, so that their SE belief increased significantly (P<0.05) and reached
a high level (Table 3).The relation between PS skills and SE was examined using the
Spearman correlation test and a medium level, negative but a statistically significant
relationship could not be found (r= -317, p=.115) (p>0.05).
Table 3.
PSI and SES Scores of Students
Score
Limits
PSI-dimensions
Quick A.**
Thinking A.
Abstention A.
Evaluative A.
Self-Confident A.
Planned A.
9-54
5-30
4-24
3-18
6-36
4-24
Before
After
Training
Training
X
S
X
S
P
25.38
13.34
12.54
7.35
15.77
9.85
5.24
4.74
5.30
3.09
4.60
3.43
25.96
10.88
14.04
6.23
13.80
8.19
7.77
4.29
5.84
2.56
4.12
3.42
.689
.035*
.252
.028*
.112
.024*
16.78
11.85
82.00
94.34
2.89
9.28
.258
.000*
PSI Total
32-192
87.00
SES Total
23-11
85.23
Wilcoxon test was applied *p<0.05
**Approach
Discussion and Conclusion
This study aimed to identify the effect of training on perceived PS skills and the
SE belief of nursing students. The training program created a significant difference in
the students' PS perception. This is in line with studies supporting the idea that
education increases PS skills (Heppner & Peterson, 1982; Lee & Brysiewicz, 2009;
Bayindir & Olgun, 2014). Nonetheless, Heppner and Peterson, stating that an
increase in PS perception does not necessarily mean an increase in skills, propose
measuring it in real settings. In developing students' PS skills, it is suggested to
evaluate PS skills throughout their nursing education; to measure real PS practices
and carry out education, as in this study, both theoretically and in real settings.
PS education in nursing is mostly given to teach the nursing process for patient
care. In this study, as in the previous study by Ancel et al. (2015), most of the
students (80.7%) stated that they had not received PS education before the training
program, although they had received nursing process education throughout their
four-year education. This finding shows that students do not perceive nursing
process as a PS process and that PS skills have to be integrated into nursing process
more clearly. At this point, future studies need to investigate how PS skills are taught
to students and what the impact of nursing process or any training is on their PS
skills. Bayindir and Olgun (2015) found no relationship between the PS skills of
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Gulsum Ancel
students and nursing process grades. Wang et al. (2004) demonstrated that PS
strategies should be integrated into the nursing process and that PS skills can be
improved. However no studies were found as to whether a management course
would improve PS skills. In this study, the content of the training program was
designed differently from the other studies to gain managerial PS skills. The
subdimensions of Reflective, Evaluative, and Planned Approaches of the students
were positively affected by this program. High academic scores of students and a
training program that consists of skills-enabling critical thinking such as the causeeffect diagraming may have an influence on the PS skills of students. The
ineffectiveness of the provided training concerning some PSI subdimensions (Quick,
Abstention, and Self-Reliable Approaches) indicate the need for more attention to
motivational strategies and problem-based teaching strategies in teaching PS, as
suggested by Cholowski and Chan (2004).
The study states that the training program also influences students' SE belief.
According to Bandura’s (1997) theory, a high level of SE belief facilitates decision
making, which is an important element of PS. At this point it is possible to create
mutuality between SE belief and perceived PS. As explained in the cognitive model
of the SE concept by Zulkosky (2009), the thinking dimension of SE may have been
positively affected by the PSI's Reflective, Evaluative, and Planned Approaches
dimensions, by enhancing decision making and success. Similarly, the failure of the
same effect in the PSI's Quick, Abstention, and Self-Reliable Approaches
subdimensions may be improved to enhance the emotional and behavioral
dimension of SE belief. When the finding of the current study was interpreted in the
context of Mayer's model (1998), it showed that the training program improved PS
perception and the students received training in a realistic setting, but the
motivational dimensions, which are an element of SE theory, need a better analysis.
For example, the students' interest and how they are seen by teachers need to be
specified, interest of the students has to be raised, and educators have to provide the
students with supportive feed-back during education. In this way, it was anticipated
that the PSI's Quick, Abstention, and Self-Reliable subdimensions could undergo a
positive change. The four sources of SE belief are guidance for this change and more
attention to the four information sources should be recommended in teaching
planning for better outcomes. The training education program for PS skills should
aim to ensure that the students gain mastery experiences, increase their vicarious
experiences, affect their verbal persuasion, and control psychological, physiological,
and emotional arousal.
In the present study, a statistically insignificant but medium-level negative
relation was found between PS and SE. Studies that have directly examined the
relation between PS training, PS skills, and SE belief have not been found in the
literature. There is one study which determined that higher critical thinking, which is
positioned as an essential concept for effective PS skills, leads to higher SE beliefs
and perceived performance (Gloudemans, Schalk, & Reynaert, 2013). Another study
which examined the PS and SE relationship indicated that better PS leads to a better
SE (Ancel et al., 2015). Therefore, nurse academicians and researchers stressed that
Eurasian Journal of Educational Research
241
focusing on this relationship will help give direction to the professional nursing
education.
This study points out that a structured training program increases cognitive
dimensions of PS skills and SE beliefs. Since PS and SE are the main concepts of
nursing education, this relationship needs to be investigated more precisely and
further studies are needed to determine how PS skills could be effectively improved.
Since there was no possibility to establish the study with a control group, it is
suggested to repeat the study with a control group and with different samples, and
to measure the real PS practices of students with longitudinal monitoring. It is also
considered that examining multidimensionally to what extent the nursing process
improves PS skills would be useful.
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Hemşirelik Öğrencilerinde Problem-Çözme Eğitiminin Problem Çözme
Becerisi ve Öz-Yeterlilik İnancına Etkisi
Atıf:
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Self-Efficacy of Nursing Students. Eurasian Journal of Educational Research, 64,
231-246, http://dx.doi.org/10.14689/ejer.2016.64.13
Özet
Problem Durumu: Hemşirelikte problem çözme (PÇ) becerisi, “hemşirelik süreci”
olarak adlandırılan ve sağlıklı ya da hasta bireylerin gereksindiği hemşirelik
bakımının belirlenmesi, uygulanması ve değerlendirilmesinde kullanılan en önemli
beceridir.
Hemşirelik
süreci,
bilimsel
PÇ
aşamalarını
kullanarak
gerçekleştirilmektedir. PÇ becerisi, iyi bir hemşirelik bakımı sunulabilmesi için
244
Gulsum Ancel
uluslararası strateji olarak belirlenmiştir. Veri toplama, verileri değerlendirerek
hemşirelik tanısı koyma (problemi belirleme), problemi çözmek için gerekli
hemşirelik bakımı girişimlerini belirleme, girişim planını uygulama ve sonucu
değerlendirme aşamalarından oluşan hemşirelik süreci, dinamik bir süreçtir. Bu
nedenle hemşirelik eğitimi veren kurumlar, topluma kaliteli bir sağlık hizmeti
sunabilmeleri için bu beceriye sahip meslek üyeleri yetiştirmek durumundadırlar.
Türkiye’de PÇ becerisi eğitimi, hemşirelik süreci sistemi adıyla ve dört yıllık lisans
eğitiminin ikinci döneminden başlayıp yedi sömestre boyunca devam etmektedir.
Öğrencilerden teorik eğitimde öğrendikleri PÇ becerisini haftada 8-16 saatlik klinik
alan/toplum sağlığı uygulamalarında kullanmaları ve geliştirmeleri beklenmektedir.
Lisans eğitimi süresince PÇ eğitimi ve uygulaması almalarına karşın, öğrencilerin
PÇ becerilerinin düşük ya da orta düzeyde olduğu ya da eğitim boyunca artmadığı
görülmektedir. Bu nedenle öğrencilerin PÇ becerilerini etkileyebilecek eğitim, eğitici,
öğrenci ya da eğitim programından kaynaklanan nedenler mutlaka incelenmeli, PÇ
becerileri ile ilişkili faktörler araştırılmalı ve farklı eğitim programları denemelidir.
Literatür taramasında, Türkiye’de hemşirelik öğrencilerinde PÇ becerilerini
artırmada mesleki yönetim dersi kapsamında verilen PÇ eğitiminin etkisi ve PÇ ile
öz-yeterlik (ÖY) inancı arasındaki ilişkinin incelendiği bir çalışmaya ulaşılamamıştır.
Hemşirelik eğitiminin etkili biçimde yapılması ve geliştirilmesi için bu konuda
çalışmalar yapılmasına gereksinim bulunmaktadır.
Araştırmanın amacı: Bu çalışma, hemşirelik öğrencilerinin PÇ becerilerinin
artırılmasında mesleki yönetim dersi kapsamında verilecek bir eğitimin etkisini
belirlemeyi amaçlamaktadır. Ayrıca öğrencilerin, PÇ becerilerini kullanabilmelerinin
bu konuda kendilerine inanmaları ile de ilişkili olduğunun düşünülmesi nedeniyle;
eğitimin ÖY inancına etkisi ve problem çözme ile öz-yeterlik arasındaki ilişkinin de
belirlenmesi amaçlanmıştır.
Araştırmanın Yöntemi: Çalışma ön test-son test uygulamalı ve deneysel olarak
planlanmıştır. Son sınıfta okuyan öğrenci sayısının çalışmaya katılanlarla sınırlı
olması ve ikinci bir grup olmaması nedeniyle kontrol grubu oluşturulamamıştır.
Çalışmaya bir üniversitenin hemşirelik lisans programına kayıtlı olan, PÇ becerisine
dayalı hemşirelik süreci eğitimi almış, son sınıfta okuyan ve mesleki yönetim
dersine kayıt yaptırmış öğrenciler alınmıştır. Örneklem seçimine gidilmemiş ve
çalışmaya katılmaya gönüllü olan 26 öğrencinin tamamı alınmıştır. Veriler
öğrencilerin sosyo-demografik özellikleriyle ilgili soru formu, Problem Çözme
Envanteri (PÇE) ve Öz-Yeterlik-Etkililik Ölçeği (ÖYÖ) kullanılarak ölçülmüştür.
PÇE’nin Cronbach alfa katsayısı çalışmamızda .87 olarak ÖYÖ’nin ise .85 olarak
hesaplanmıştır. Öğrencilere mesleki yönetim dersi kapsamında 8 saati kuramsal, 56
saati uygulamadan oluşan 7 haftalık bir eğitim verilmiştir. Kuramsal eğitim,
problem kavramı ve tanımı, problemin belirlenmesi ve ifade edilmesi, çözüm
seçeneklerini sıralama, seçeneklerin avantaj ve dezavantajlarını karşılaştırarak uygun
seçeneğe karar verme, çözümü uygulamak için eylem basamaklarının oluşturulması
ve değerlendirme için sonuç çıktılarını belirleme konularını kapsamaktadır.
Kuramsal eğitimde, ayrıca öncelikli problemi belirleyebilmek için “Pareto Analizi”,
Eurasian Journal of Educational Research
245
kök nedenleri bulabilmek için “Ishikawa Diyagramı”, problem çözümünde sahip
olunan güçlü (Strength) ve zayıf (Weakness) yanlar ile tehditler (Threats) ve fırsatları
(Oportunities) değerlendirebilmek amacıyla “SWOT Analizi” gibi teknikler
öğretilmiştir. Kuramsal eğitim, sınıf içi uygulamalar, bireysel ve grup çalışmaları, ev
ödevleri ve son olarak ta klinik ortamda yapılan tartışmalarla pekiştirilmiştir.
Öğrenciler egzersizlerle önce kendi yaşamlarında karşılaştıkları problemleri çözme
konusunda cesaretlendirilmişlerdir. İkinci aşamada, bir üniversite hastanesinin
kliniğinde, belirledikleri bir yönetimsel problem çözümü için uygulama
yapmışlardır. Veriler, SPSS (Statistical Packages for Social Sciences) 15. paketi ile
değerlendirilmiş, tanımlayıcı istatistik analizler, öğrencilerin eğitim öncesi ve sonrası
PÇE ve ÖYÖ puanlarındaki değişimi belirlemek için Wilcoxon Testi ve ölçekler arası
ilişki için Spearman Korelasyon Testi kullanılmıştır. Anlamlılık düzeyi 0.05 olarak
kabul edilmiştir.
Araştırmanın Bulguları: Öğrencilerin % 80.7 sinin eğitimleri boyunca hemşirelik süreci
eğitimi almalarına karşın PÇ eğitimi almadıklarını belirtmeleri, hemşirelik süreci
eğitiminin PÇ becerisi ile ilişkilendirilerek öğretilmesinde sorun olduğunu
göstermiştir. Çalışma bulguları, mesleki yönetim dersi kapsamında yapılandırılmış
bir PÇ eğitiminin öğrencilerin PÇ becerileri ve ÖY inancını artırabileceğini ortaya
koymuştur. Eğitim öncesi öğrencilerin PÇE puanlarının 87.0±16.7(81-192 arası
düşük), eğitim sonrası 82±12.9, olduğu (puan azaldıkça yeterli hissetme düzeyi
yükselmektedir) ve ÖY inancı puanlarının eğitim öncesi 85.23±11.8, sonrası 94.35±9.3
olduğu (puan arttıkça yeterlik inancı artmaktadır) belirlenmiştir. Eğitimle PÇE’nin
“düşünen yaklaşım” “değerlendirici yaklaşım” ve “planlı yaklaşım” alt boyut
puanlarında istatistiksel olarak anlamlı değişim olduğu ve öğrencilerin kendilerini
daha yetkin algıladıkları görülmüştür (p<0.05). PÇE’nin “Kendine güvenli yaklaşım”
alt boyutunda ise istatistiksel olarak anlamlı olmasa da olumlu bir değişim
görülmüştür. Aynı şekilde, ÖY inançlarında da anlamlı bir artış olduğu (p<0.05)
belirlenmiştir. PÇ becerisi ve ÖY inancı arasında orta düzeyde, negatif ancak,
istatistiksel olarak anlamlı bir ilişki bulunamamıştır (p=.072).
Araştırmanın Sonuçları ve Önerileri: Öğrencilere verilen eğitim, problem çözmede
olumlu alt boyutlar olarak anılan “düşünen, değerlendirici ve planlı yaklaşım” üç alt
boyutunda istatistiksel olarak anlamlı bir değişim “kendine güvenli yaklaşım” alt
boyutunda ise istatistiksel olarak anlamlı olmasa da olumlu bir değişim sağlamıştır.
Ancak, problem çözmede olumsuz boyutlar olarak anılan ”aceleci yaklaşım” ve
“kaçıngan yaklaşım” alt boyutlarında anlamlı bir değişimin olmaması, verilen
eğitimin problem çözmenin bilişsel boyutunu etkilediği ve duyuşsal boyutu
etkilemesi için farklı
stratejiler gerektiğini düşündürmüştür. Eğitim sonrası
öğrencilerin ÖYÖ puanının artmış olmasına karşın PÇE’nin “kendine güvenli
yaklaşım” ve duyuşsal boyutlarında farklılık yaratmaması ve PÇ becerisi ve ÖY
inancı arasında istatistiksel olarak ilişki bulunmaması ilgi çekicidir. Çalışmada
ÖYÖ’nin alt boyutlarının kullanılamaması (ölçeğin geçerlik güvenirlik çalışmasında
önerilmemiştir) nedeniyle ölçekler arası ilişki toplam puanlar üzerinden
çalışılabilmiş, bu nedenle, alt boyutlar arasında karşılaştırma yapmak mümkün
246
Gulsum Ancel
olamamıştır. Çalışmanın bulguları, öğrencilere verilecek yapılandırılmış bir PÇ
eğitiminin PÇ becerisini ve ÖY inancını arttırabileceğini göstermektedir. Ancak,
kontrol gruplu ve her iki cinsiyette öğrencinin olduğu farklı örneklemlerle
çalışmanın tekrarlanması ve uzunlamasına izlemle öğrencinin gerçek PÇ
eylemlerinin ölçülmesi daha güvenilir kanıtlar sağlayacağı için önerilir. Ayrıca
hemşirelik öğrencilerine verilen eğitimin sosyal kognitif teoriler açısından gözden
geçirilmesinin ve hemşirelik süreci içerisinde PÇ becerisini geliştirici değişiklikler
yapılmasının etkili ve yararlı olacağı düşünülmüştür.
Anahtar Kelimeler: Hemşirelik süreci, hemşirelik, eğitim, yönetim dersi.